Healthcare Provider Details

I. General information

NPI: 1710890314
Provider Name (Legal Business Name): THE SPLIT SECOND FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 GENTILLY BLVD STE C-18
NEW ORLEANS LA
70119-1700
US

IV. Provider business mailing address

2236 ORIOLE ST
NEW ORLEANS LA
70122-4334
US

V. Phone/Fax

Practice location:
  • Phone: 504-354-2149
  • Fax:
Mailing address:
  • Phone: 504-430-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK RAYMOND JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 504-430-9429